Can the two questions of the PHQ-2 screen effectively for depression?

Author/s
Rachel Wilson, Mark Agius
Citation
Issue 5 Winter 2018
CEPiP.2018.1.76-80
Abstract

The PHQ-2 has been presented as an ultra-short screening questionnaire to detect depression in several healthcare settings. It consists of two questions on low mood and anhedonia, both questions being derived from the more accurate PHQ-9. The PHQ-2 is to be used as an initial screening tool for patients with possible depression, which can then be evaluated in more detail using other tools, such as the PHQ-9. The PHQ-2 is both reliable and valid as a screening tool. Sensitivity and specificity do depend on the threshold score used in evaluating the PHQ-2. When a threshold of three is used, the PHQ-2 is highly specific, but with lower sensitivity. The PHQ-2 is not currently used as widely as it could be and, in many situations, depression continues to be underdiagnosed. We hypothesize that, if used routinely in several situations, the identification of depression would be much improved.

Keywords: depression, PHQ-2 screening

Cite as: Cutting Edge Psychiatry in Practice 2018, 5(1):76-80; https://doi.org/10.65031/rduo6053

References

  1. Carroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N,Fishman T, Falloon K, Hatcher S. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine 2010; 8:4. https://doi.org/10.1370/afm.1139
  2. Al-Qadhi W, Ur Rahman S, Ferwana MS, AbdulmajeedIA. Adult depression screening in Saudi primary care: prevalence, instrument and cost. BMC Psychiatry 2014; 14:190. https://doi.org/10.1186/1471-244x-14-190
  3. Bhana A, Rathod SD, Selohilwe O, Kathree T, Petersen I. The validity of the Patient Health Questionnaire for screening depression in chronic care patients in primary health care in South Africa. BMC Psychiatry 2015; 15:118. https://doi.org/10.1186/s12888-015-0503-0
  4. Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. Annals Family Medicine 2009; 7:1. https://doi.org/10.1370/afm.933
  5. Choi SK, Boyle E, Burchell AN, Gardner S, Collins E, Goaltenders P, Rourke SB, OHTN Cohort Study Group. Validation of Six Short and Ultra-short Screening Instruments for Depression for People Living with HIV in Ontario: Results from the Ontario HIV Treatment Network Cohort Study. PLOS One 2015; 10:11. https://doi.org/10.1371/journal.pone.0142706
  6. Zhang YL, Liang W, Chen ZM, Zhang HM, Zhang JH, Weng XQ, Yang SC, Zhang L, Shen LJ, Zhang YL. Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China. Asia Pacific Psychiatry 2013; 5:4. https://doi.org/10.1111/appy.12103
  7. Margrove KL, Thapar AK, Mensah SA, Kerr MP. Helpseeking and treatment preferences for depression in epilepsy. Epilepsy & Behavior 2011; 4:22. https://doi.org/10.1016/j.yebeh.2011.08.042
  8. Mitchell AJ, Kaar S, Coggan C, Herdman J. Acceptability of common screening methods used to detect distress and related mood disorders-preferences of cancer specialists and non-specialists. Psychooncology 2008; 3:17. https://doi.org/10.1002/pon.1228
  9. Zuithoff NP, Vergouwe Y, King M, Nazareth I, van Wezep MJ, Moons KG, Geerlings MI. The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a cross-sectional study. BMC Family Practice 2010; 98:11. https://doi.org/10.1186/1471-2296-11-98
  10. Schlosser RJ, Hyer JM, Smith TL, Mace JC, Cortese BM, Uhde TW, Rudmik L, Soler ZM. Depression-specific outcomes after treatment of chronic rhinosinusitis. JAMA Otolaryngology Head & Neck Surgery 2016; 4:142. https://doi.org/10.1001/jamaoto.2015.3810
  11. Corson K, Gerrity MS, Dobscha SK. Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. American Journal of Managed Care 2004; 11:10.         
  12. Fuchs CH, Haradhvala N, Hubley S, Nash JM, Keller MB, Ashley D, Weistberg RB, Ueblacker LA. Physician actions following a positive PHQ-2: implications for the implementation of depression screening in family medicine practice. Families Systems and Health 2015; 1:33. https://doi.org/10.1037/fsh0000089
  13. Inagaki M, Ohtsuki T, Yonemoto N, Kawashima Y, Saitoh A, Oikawa Y, Kurosawa M, Muramatsu K, Furukawa TA, Yamada M. Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study. General Hospital Psychiatry 2013; 6:35. https://doi.org/10.1016/j.genhosppsych.2013.08.001
  14. Li C, Friedman B, Conwell Y, Fiscella K. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. Journal of the American Geriatric Society 2007; 4:55. https://doi.org/10.1111/j.1532-5415.2007.01103.x
  15. Loeb D, Sieja A, Corral J, Zehnder NG, Guilton G, Nease DE. Evaluation of the role of training in the implementation of a depression screening and treatment protocol in 2 academic outpatient internal medicine clinics utilizing the electronic medical record. American Journal of Medical Quality 2015; 4:30. https://doi.org/10.1177/1062860614532681
  16. Thombs BD, Ziegelstein RC, Whooley MA. Optimizing detection of major depression among patients with coronary artery disease using the patient health questionnaire: data from the heart and soul study. Journal of General Internal Medicine 2008; 12:23. https://doi.org/10.1007/s11606-008-0802-y
  17. Elderon L, Smolderen KG, Na B, Whooley MA. Accuracy and prognostic value of American Heart Association: recommended depression screening in patients with coronary heart disease: data from the Heart and Soul Study. Circulation: Cardiovascular Quality and Outcomes 2011; 5:4. https://doi.org/10.1161/circoutcomes.110.960302
  18. Richardson LP, Rockhill C, Russo JE, Grossman DC, Richards J, McCarty C, McCauley E, Katon W. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics 2010; 5:125. https://doi.org/10.1542/peds.2009-2712
  19. Sudhanthat S, Thakur K, Sigal Y, Turner J. Improving validated depression screen among adolescent population in primary care practice using electronic health records (EHR). BMJ Quality Improvement Reports 2015; 1:4 https://doi.org/10.1136/bmjquality.u209517.w3913
  20. Soltani M, Smith S, Beck E, Johnson M. Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic. Academic Psychiatry 2015; 3(39). https://doi.org/10.1007/s40596-014-0257-x
  21. Yu X, Stewart SM, Wong PT, Lam TH. Screening for depression with the Patient Health Questionnaire-2 (PHQ-2) among the general population in Hong Kong. Journal of Affective Disorders 2011; 1-3:134. https://doi.org/10.1016/j.jad.2011.05.007
  22. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care 2003; 11:41. https://doi.org/10.1097/01.mlr.0000093487.78664.3c
  23. Liu ZW, Yu Y, Hu M, Liu HM, Zhou L, Xiao SY. PHQ-9 and PHQ-2 for screening depression in Chinese rural elderly. PLOS One 2016; 3:11. https://doi.org/10.1371/journal.pone.0151042
  24. Suzuki K, Kumei S, Ohhira M, Nozu T, OkumuraT. Screening for major depressive disorder with the Patient Health Questionnaire (PHQ-9 and PHQ-2) in an outpatient clinic staffed by primary care physicians in Japan: a case control study. PLOS One 2015; 3:10. https://doi.org/10.1371/journal.pone.0119147
  25. Thapar A, Hammerton G, Collishaw S, Potter R, Rice F,Harold G, Craddock N, Thapar A, Smith DJ. Detecting recurrent major depressive disorder within primary care rapidly and reliably using short questionnaire measures. British Journal of General Practice 2014; 618:64. https://doi.org/10.3399/bjgp14x676438
  26. Mitchell AJ, Lord K, Symonds P. Which symptoms are indicative of DSMIV depression in cancer settings? An analysis of the diagnostic significance of somatic and nonsomatic symptoms. Journal of Affective Disorders 2012; 1-2:2012. https://doi.org/10.1016/j.jad.2011.11.009
  27. Mitchell, AJ. Clinical utility of screening for clinical depression and bipolar disorder. Current Opinion in Psychiatry 2012; 1:25. https://doi.org/10.1097/yco.0b013e32834de45b
  28. Thombs BD, Benedetti A, Kloda LA, Levis B, NicolauI,Cuijpers P, Gilbody S, Ioannidis JP, McMillan D, Patten SB, Shrier I, Steele RJ, Ziegelstein RC. The diagnostic accuracy of the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-8 (PHQ-8), and Patient Health Questionnaire-9 (PHQ-9) for detecting major depression: protocol for a systematic review and individual patient meta-analyses. Systematic Reviews 2014; 124:3. https://doi.org/10.1186/2046-4053-3-124
  29. Haugen W, Haavet OR, Sirpal MK, Christensen KS. Identifying depression among adolescents using three key questions: a validation study in primary care. British Journal of General Practice 2016; 643:66. https://doi.org/10.3399/bjgp16x683461
  30. Wang L, Lu K, Li J, Sheng L, Ding R, Hu D. Value of patient health questionnaires (PHQ)-9 and PHQ-2 for screening depression disorders in cardiovascular outpatients. Zhonghua Xin Xue Guan Bing ZaZhi 2015; 5:43.
  31. Warren AM, Reynolds M, Foreman ML, Bennett MM, Weddle RJ, Austin JD, Roden-Foreman K, Petrey LB. Validation of a brief, two-question depression screen in trauma patients. Journal of Trauma and Acute Care Surgery 2016; 2:80. https://doi.org/10.1097/ta.0000000000000898
  32. Smits N, Finkelman MD. Shortening the PHQ-9: a proof-of-principle study of utilizing Stochastic Curtailment as a method for constructing ultrashort screening instruments. General Hospital Psychiatry 2015; 5:37 https://doi.org/10.1016/j.genhosppsych.2015.04.011
  33. Cusimano P, Palermo A, Locascio G. Screening for depression in heamodialysis. Giornale Italiano di Nefrologia 2015; 3:32. 
  34. Carey M, Boyes A, Noble N, Waller A, Inder K. Validation of the PHQ-2 against the PHQ-9 for detecting depression in a large sample of Australian general practice patients. Australian Journal of Primary Health 2016; 22:262-6. https://doi.org/10.1071/py14149